| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,411 |
6,447 |
$2.97M |
| D0140 |
Limited oral evaluation - problem focused |
1,650 |
1,598 |
$34K |
| D1206 |
Topical application of fluoride varnish |
2,364 |
2,258 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,079 |
1,040 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
298 |
197 |
$19K |
| D0274 |
Bitewings - four radiographic images |
821 |
800 |
$10K |
| D0330 |
Panoramic radiographic image |
342 |
335 |
$9K |
| D1120 |
Prophylaxis - child |
482 |
449 |
$9K |
| D1110 |
Prophylaxis - adult |
249 |
246 |
$9K |
| D1351 |
Sealant - per tooth |
447 |
99 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
112 |
107 |
$830.08 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$102.90 |
| D1330 |
|
28 |
28 |
$0.00 |